Provider Demographics
NPI:1861749962
Name:FORNISHI, PATRICIA SHURI (NURSE)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:SHURI
Last Name:FORNISHI
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:SHURI
Other - Last Name:FORNISHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NURSE
Mailing Address - Street 1:8830 STONEBROOK LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1414
Mailing Address - Country:US
Mailing Address - Phone:240-899-6861
Mailing Address - Fax:
Practice Address - Street 1:8830 STONEBROOK LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1414
Practice Address - Country:US
Practice Address - Phone:240-899-6861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC143401374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide